The optimal management of below the knee pathology remains one of the most challenging areas for revascularization in patients presenting with critical limb threatening ischemia. Patients commonly have multilevel lesions and have a high amputation rate and associated mortality. This review aimed to assess the outcomes of below the knee revascularization strategies.
An online literature search of medical databases for original articles or review articles was conducted using mesh terms.
Bypass surgery remains the gold standard for revascularization with good long-term outcomes with regards to patency, limb salvage, and quality of life but is associated with a higher morbidity than the endovascular approach. Given the increasing frailty of our patients, endovascular treatments have become the preferred strategy with results that are now equal to bypass. Hybrid surgery is an increasingly popular option as it combines the benefits of both endovascular and open surgery and although the evidence base is small the outcomes are encouraging.
Hybrid surgery offers promising results and could be considered in the treatment of multi-level lower limb arterial disease especially in high-risk patients or those who are not suitable for either open or endovascular techniques as a sole treatment modality.
Hybrid surgery offers promising results and could be considered in the treatment of multi-level lower limb arterial disease especially in high-risk patients or those who are not suitable for either open or endovascular techniques as a sole treatment modality.Implant dentistry has become a popular restorative option in clinical practice. Titanium and titanium alloys (TTA) are the gold standard for endo-osseus dental implants production, thanks to their biocompatibility, resistance to corrosion and mechanical properties. The characteristics of the TTA implant surface seem to be particularly relevant in the early phase of osseointegration. Furthermore, the microstructure of implant surface can largely influence the bone remodelling at the level of the bone-implant surface. Recently, research has stated on the long-term of both survival and success rates of osseointegrated implants and mainly on biomechanical aspects, such as load distribution and biochemical and histological processes at the bone-implant interface. This short review reports recent knowledge on chemical and mechanical properties, biological aspects, innovations in preventing peri-implantitis, describing clinical applications and recent improvements of TTA dental implants. In addition, it highlights current knowledge about a new implant coating that has been demonstrated to reduce the number of initially adhering bacteria and peri-implantitis.Helicobacter pylori bacteria (HPB) is one of the most common gastric infections in the world. It seems that HPB infects the subject early in life and is transmitted from person to person. The oral cavity could be a reservoir of HPB participating in infection transmission. HPB and recurrent aphthous stomatitis (RAS) show similar clinical and histological findings, and the discovery of HPB in RAS ulcers support the idea of a correlation between the two diseases. Another important relationship between RAS and HPB is the high incidence of anemia in patients with RAS that may be caused by HPB. In fact, antibiotic therapy and treatment of anemia can reduce the frequency of RAS ulcer recurrence. HPB is considered a carcinogenic agent type 1 of the stomach. In conclusion, the oral cavity is an extra-gastric reservoir of HPB and periodontal therapy associated with systemic therapy can better eradicate HPB from the mucosa of all gastro-enteric tract. Prospective cohort studies are needed to demonstrate the bacterial action in the oral cavity.Gingivitis and periodontitis (GP) are the main diseases of the oral cavity. The ethiology of GP have never been completely understood, however, loss of balance between the host immune system and the microbial virulence of GP pathogens may be considered the trigger of GP. In fact, the immune system, activated by microbiological agents, attacks the host and not the biofilm bacteria, causing the destruction of periodontal tissue, alveolar bone, and loss of teeth. Parasites may play an important role in the pathology of GP. The first studied and the most common parasite in the oral cavity is Entamoeba gingivalis. A possible link between E. gingivalis and GP has never been demonstrated completely, however E. gingivalis is infrequently found in people without GP. In addition, there is evidence that E. gingivalis could favour the onset and progression of GP. In conclusion, we can assert that E. gingivalis and GP may be correlated. This relationship can open new therapeutical approaches for treating GP, particularly in cases refractory to therapy.Reconstructive surgery (RS) is necessary before implant placement to regenerate bone defects. Success rate of implants is related to RS and to the correct position of implants in residual crest. The most popular surgical procedures of RS are bone grafts, guided bone regeneration. Bone graft is the gold standard technique to achieve RS of edentulous crests. RS is a surgical technique that uses barrier membranes to promote osteoblast cells proliferation. RS is often combined with bone grafting procedures. Sinus floor elevation procedures are elective treatments when there is insufficient bone height for implant insertion in maxilla. Bone osteogenesis distraction is the process of RS between two bone segments in response to tensile stress. The aim of this short review is to analyze the different methods of RS bone grafts, guided bone regeneration, maxillary sinus floor elevation, and bone osteogenesis distraction.Implant dentistry has emerged as a first line of treatment to replace missing teeth for both the edentulous and partially dentate patients. Implant dentistry is accompanied by the onset of peri-implantitis (PIM). PIM is characterized by the inflammatory destruction of the implant-supporting tissues, because of biofilm formation on the implant surface. https://www.selleckchem.com/products/wortmannin.html A history of periodontitis, poor oral hygiene, and smoking are considered as risk factors for PIM. Occasionally PIM is associated with iatrogenic factors, that, only recently, have been acknowledged as direct cause of PIM, i.e. non-parallel adjacent implants or the presence of a gap, between fixture and prosthetic components. The use both of traditional protocols of nonsurgical periodontal therapy and the laser seems to be an effective alternative treatment modality for PMI. By the application of laser-assisted non-surgical peri-implant therapy the periodontal pocket depth was reduced. The present article illustrates the nonsurgical management of one case, where failure to remove residual cement, from an implant-supported dental prosthesis, seemed to cause PMI.